To manage postprandial hyperglycemia in type 2 diabetes with standard basal insulin, which approach is recommended?

• A. Increase basal insulin only
• B. Stop all insulin and switch to oral agents
• C. Consider adding prandial mealtime insulin or GLP-1 receptor agonist; adjust ICR
• D. Use higher-dose insulin but no other adjustments

Answer: (C)

Postprandial hyperglycemia arises when basal insulin can’t cover the rise in glucose that comes with meals. The way to address this is to provide meal-time coverage: add a prandial (mealtime) insulin to deliver a bolus with meals, or use a GLP-1 receptor agonist, which helps control post-meal glucose and can complement basal insulin. Pairing this with an adjustment of the insulin-to-carbohydrate ratio tailors the bolus dose to the amount of carbohydrate eaten, reducing post-meal spikes while avoiding unnecessary hypoglycemia. Merely increasing the basal dose won’t fix post-meal elevations and can bring other risks. Stopping insulin and switching to oral agents removes the needed meal-time coverage, which is not appropriate when postprandial levels remain high. Increasing insulin without timing or carb adjustments also misses the timing of glucose rises, making control less effective.